Predicting pressure ulcer risk: comparing the predictive validity of 4 scales.

OBJECTIVE To compare the predictive validity of 4 pressure ulcer risk assessment tools. METHODS Prospective clinical design in which 230 subjects free of pressure ulceration on admission were assessed using the Braden, Gosnell, Norton, and Waterlow scales within 48 hours of admission. Subjects' skin condition was assessed once every 24 hours for a minimum of 14 days to identify any skin breakdown. RESULTS Based on Youden's index, the Gosnell Scale had better predictive validity in identifying patients at risk for pressure ulcer development (J = 68%). The other scales did not predict individuals at risk with high accuracy, despite having high sensitivity and specificity. CONCLUSION Numerous pressure ulcer risk assessment tools have been developed, but sufficient evidence for using one tool over another does not exist. In this study, the Gosnell Scale was found to be more appropriate for application in patients with neurologic and orthopedic conditions. CLINICAL RELEVANCE Being able to predict which patients are at risk for pressure ulcers can assist practitioners in tailoring care to prevent unnecessary complications and suffering, as well as reduce costs.